NJ Disaster Triage Tag Request Form, Office of Emergency Medical Services

If you require additional tags, please complete the form below and click submit. Your request form will be forwarded to the Office of Emergency Medical Services for processing. Your triage tags will be sent within five business days. Should you have any questions, please feel free to call the office at (609) 633-7777.

To guarantee prompt delivery please complete this form in its entirety including any special comments.

Agency Name:

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Agency Address:

Street:
City:
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(if different from above)
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Number of New Jersey Disaster Triage Tags Requested:
(enter '0' if you don't want any)

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Last Modified: Wednesday, 11-Jun-08 12:00:04